Land Disturbing Application

Land Disturbing Application

City of Homewood Building, Engineering & Zoning Department
2850 19th Street South
Phone (205) 332-6800
Fax (205) 332-6955

Tree conservation permit application required for approval. No mud or silt will be permitted to run onto adjacent properties. If the applicant has a NPDES CONSTRUCTION PERMIT issued by ADEM, a copy of the permit and a copy of the approved BMP plan is required for issuance of this permit.
Contractor/Applicant Company Name*
Contractor/Applicant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contractor/Applicant Email*
example@example.com
Contractor/Applicant Phone Number*

Area CodePhone Number
Licensed Contractor? *
State of Alabama License #:
Job Site Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Owner Name*

First NameLast Name
Property Owner Email*
example@example.com
Property Owner Phone Number*

Area CodePhone Number

Description 1*
Description 2*
Brief description of job:*

Erosion & sedimentation control plan prepared by:
Title*

CPESCLandscape ArchitectProfessional EngineerRegistered ArchitectRegistered Environmental ManagerRegistered ForesterRegistered GeologistRegistered Land Surveyor
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number

Cost of Project*
Permit Fee
E-Signature of Company/Applicant Representative *

First NameLast Name
Today's Date*

MonthDayYear
Date
*By signing your name electronically on this form, you are agreeing that your
electronic signature is the legal equivalent of your manual signature.
Should be Empty: